Each year in the U.S. approximately 220,000 infants are born to mothers who used illicit drugs during pregnancy. Others report between 4-10% of all pregnant women have used cocaine. There is growing evidence that in utero drug exposure (IUDE) to cocaine constitutes a risk leading to long-term alterations of brain functioning. Long term follow-up studies of opiate exposed children indicate that although intellectual deficits may be mild or nonexistent, behavioral abnormalities may persists into the school years. One major difficulty in studying opiate exposed children is determining which factors (environmental or direct effects or opiate exposure) result in the poor outcomes. Foster care placement for IUDE children is high. Almost half (43%) of opiate exposed children were removed from the biological parent in one longitudinal study. Cost burden of drug exposed infants are a direct result of the high incidence of prematurity, low birthweight and neonatal drug withdrawal symptoms. Neonatal drug withdrawal occurs in 42-68% in heroin addicted and 63-85% of methadone addicted newborns contributing to an increased length of stay. Other cost burdens are difficult to measure including the effects on the development and performance of the individual over a lifetime Early intervention programs including home nurse interventions are thought to enhance parenting to enrich the development in biologically and environmentally challenged infants. The goal of this continuation study is to determine if a Pediatric Nurse Specialist (PNS) home intervention will be associated with sustained effects of improved child health and demonstrate cost effectiveness in the 204 enrolled in utero drug exposed infants up to age 5 years. Additionally, the goal is to compare the intervention children to a group of non-drug-exposed control infants of comparable environment/ socioeconomic status. This ongoing study is a randomized, two-group, repeated measures controlled clinical trial to test the effectiveness of a home-based PNS intervention. Infants were randomized into the PNS intervention (N=100) or control (N=100) groups. All 204 IUDE infants were born at the Johns Hopkins Hospital and had documented IUDE based on maternal drug history by review of prenatal records and maternal urine toxicology screens at delivery and/or infant urine toxicology screens obtained within 24 hours of birth. Starting in December 1, 1996, a non-exposed control group has been recruited from pediatric clinics at the Johns Hopkins Hospital to appreciate the full impact of the intervention.